Comment
Author: Admin | 2025-04-28
Onset of therapeutic effect is particularly important, such as in severe depression, fluoxetine may not be the SSRI of choice. Patients in whom the long half-life may have advantages (and therefore for whom fluoxetine should be considered) include those who are poorly compliant and those in whom administration less frequent than daily is contemplated. Sertraline exhibits a sex- and age-dependent half-life. In men, the half-life is approximately 30% shorter (22.4 hr) than in females or the elderly (32.1-36.7 hr). Linear and nonlinear pharmacokinetic One of the important differences to note among the SSRIs is whether their pharmacokinetic properties are linear or nonlinear. Citalopram, escitalopram and sertraline show linear and dose-proportional pharmacokinetics (changes in drug concentration proportional to the change in dose). Plasma concentrations of these drugs are proportional to the daily dose administered and, therefore, predictable. In contrast, fluvoxamine, fluoxetine and paroxetine have non-linear pharmacokinetics. Higher doses may produce much greater increases in plasma drug concentrations than would otherwise be expected. Thus, increasing the dose of paroxetine or fluoxetine can result in disproportionate and unpredictable increases in plasma levels, half-lives, and ADEs. Titration of fluoxetine and paroxetine doses may therefore be more difficult than with citalopram, escitalopram and sertraline. Protein binding Fluoxetine, paroxetine and sertraline are highly protein bound. In contrast, the protein binding of citalopram (50%) and fluvoxamine (77%) is considerably less. What is the best SSRI? Balancing benefits, side effects, cost Head-to-head comparisons: Citalopram vs Fluoxetine Escitalopram vs Paroxetine Escitalopram vs Citalopram Fluoxetine vs Paroxetine Sertraline vs Fluoxetine It is difficult to say which antidepressant is the best because each person is different. No one antidepressant is going to be an ideal answer for every person. Clinically important differences exist between antidepressants for both efficacy and acceptability in favour of escitalopram and sertraline, according to the recent antidepressant meta-analysis reported in The Lancet30. Sertraline may be the best choice when starting treatment for moderate to severe major depression because it has the most favourable balance between benefits, side effects, and acquisition cost. A major drawback with escitalopram is a relatively high cost of its generic version. However, European
Add Comment